Interstate medical journal . According to Carmen, three forms of spasm due to gastric ulcermay be recognized; first, the hour-glass stomach; second, diffuse 942 INTERSTATE MEDICAL JOURNAL spastic distortion; third, spasm of the pyloric sphincter. In in-durated gastric ulcer careful examination, particularly by the platemethod, will often reveal permanent indentations and impairedlocal peristalsis. Duodenal ulcer offers a more fruitful field than gastric the bulbar cap is clean cut, well defined, regular in out-line, and inclined toward symmetry. It appears to be continuouswith t
Interstate medical journal . According to Carmen, three forms of spasm due to gastric ulcermay be recognized; first, the hour-glass stomach; second, diffuse 942 INTERSTATE MEDICAL JOURNAL spastic distortion; third, spasm of the pyloric sphincter. In in-durated gastric ulcer careful examination, particularly by the platemethod, will often reveal permanent indentations and impairedlocal peristalsis. Duodenal ulcer offers a more fruitful field than gastric the bulbar cap is clean cut, well defined, regular in out-line, and inclined toward symmetry. It appears to be continuouswith the pylorus, being separated from it by the sphincter demar-cation ; the sulcus thus formed is about one-fourth inch wide. Hereagain the fluoroscopic and plate methods should be used; in thisinstance, in my opinion, the serial plate examination greatly excels. Via. !».— Duodenum pulled toward region of gall-bladder, due to iidhesions follovvin-chronic cholecystitis. the fluoroscopic examination. Serial radiography is becom-ing the method in which most reliance is to be placed. Thevalue of fluoroscopy should not be minimized, and it must alwaysbe used jointly with the serial plate method. The duodenum is most readily visualized by having the patientlie on the right side, then suddenly turn on his back, at which timepressure is exerted at the duodenojejunal angle, thereby incar-cerating its contents; at the same time the gastric contents shouldbe forced toward the pylorus. (Case.) Characteristic findings of duodenal ulcers are distortions of thebiilbns duodeni. Occasionally cap deformities, as observed roent-genologically, far exceed the pathologic evidences as determinedby surgery, and therefore the supposition is that intrinsic spasms Hubeny: Gastrointestinal Roentgenology 943 of the caput occur similar to gastric spasma associated with
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